Jeffrey Edmeades

Do changes in spousal employment status lead to domestic violence? Insights from a prospective study in Bangalore, India

The prevalence of physical domestic violence--violence against women perpetrated by husbands--is staggeringly high across the Indian subcontinent. Although gender-based power dynamics are thought to underlie womens vulnerability, relatively little is known about risk and protective factors. This prospective study in southern India examined the association between key economic aspects of gender-based power, namely spousal employment status, and physical domestic violence. In 2005-2006, 744 married women, aged 16-25, residing in low-income communities in Bangalore, India were enrolled in the study. Data were collected at enrollment, 12 and 24 months. Multivariable logistic regression models were used to examine the prospective association between womens employment status, their perceptions of their husbands employment stability, and domestic violence. Women who were unemployed at one visit and began employment by the next visit had an 80% higher odds of violence, as compared to women who maintained their unemployed status. Similarly, women whose husbands had stable employment at one visit and newly had difficulty with employment had 1.7 times the odds of violence, as compared to women whose husbands maintained their stable employment. To our knowledge, this study is the first from a developing country to confirm that changes in spousal employment status are associated with subsequent changes in violence risk. It points to the complex challenges of violence prevention, including the need for interventions among men and gender-transformative approaches to promote gender-equitable attitudes, practices and norms among men and women.

Migrant remittances and the web of family obligations: Ongoing support among spatially extended kin in North-east Thailand, 1984–94

Exchanges of money, goods, and assistance among family/kin members are influenced by the intertwined lives of individuals and their family/kin. As people pass through the young adulthood years, acquiring obligations as spouses and parents, and migrating in search of economic opportunities, tensions can arise over existing obligations. Using rich longitudinal data from Northeast Thailand, we examined the role of family networks (origin and destination) on migrants’ exchanges with family/kin. Our approach overcame many shortcomings of earlier studies, allowing us to ‘see’ the family social network arrayed in a broader network. We show that intra-family exchanges are influenced by marital status, the presence of children, having parents in the origin household, and having siblings depart from it. The results are stable across sensitivity tests that systematically include or exclude various familial links. In addition, reports provided by origin households on migrant remittances are consistent with reports from migrants themselves.

Methodological Innovation in Studying Abortion in Developing Countries: A ‘‘Narrative’’ Quantitative Survey in Madhya Pradesh, India

This article describes the development and implementation of a mixed methods data collection method designed to provide high-quality data on the circumstances surrounding abortion in Madhya Pradesh, India. Data collection took place between 2000 and 2002, beginning with a qualitative phase and culminating in a large-scale, representative survey. The survey itself melded a unique narrative interviewing technique with quantitative survey techniques and collected information on 11,341 individual pregnancies from 2,444 women, with a 97% response rate. Abortion rates calculated using these data are found to be roughly five times higher than the National Family Health Survey-2, a comparable sample using more traditional interviewing techniques, suggesting that this approach reduces the underreporting of abortion while providing the contextual information often lacking in survey data.

Son preference and sterilisation use among young married women in two slums in Bengaluru city, India.

Abstract This paper explores the ways in which womens sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16–25 to explore how having sons and the number of children influence a womans sterilisation decision. Discrete-time event history techniques are used to estimate two models: the first examines the effect of having sons and number of children separately, and the second examines them in combination in the form of an interaction. The results suggest sterilisation is motivated by son preference mainly at lower parities (three or fewer children) and by concerns about family size at higher parities. Understanding how sterilisation and other reproductive behaviours are influenced by the interaction of family size and sex preferences will help policy-makers and programmers to meet the needs of women while continuing to address discriminatory behaviour against females.

If your husband calls you have to go: understanding sexual agency among young married women in urban South India.

BACKGROUND Early marriage is common in many developing countries, including India. Women who marry early have little power within their marriage, particularly in the sexual domain. Research is limited on womens ability to control their marital sexual experiences. METHODS We identified factors affecting sexual communication among married women aged 16-25, in Bangalore, India, and how factors associated with sexual communication differed from those influencing non-sexual agency. We ran ordered logit regression models for one outcome of sexual agency (sexual communication, n = 735) and two outcomes of non-sexual agency (fertility control, n = 735, and financial decision-making, n = 728). RESULTS Sexual communication was more restricted (83 women (11.3%) with high sexual communication) than financial decision-making (183 women (25.1%) with high financial decision-making agency) and fertility control (238 women (32.4%) with high fertility control). Feeling prepared before the first sexual experience was significantly associated with sexual communication (odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.13-2.89). Longer marriage duration (OR 2.13; 95% CI = 1.42-3.20) and having worked pre-marriage (OR 1.38; 95% CI = 1.02-1.86) were also significant. Few other measures of womens resources increased their odds of sexual communication. Education, having children, pre-marital vocational training and marital intimacy were significant for non-sexual outcomes but not sexual communication. CONCLUSIONS Policy-makers seeking to enhance young married womens sexual communication need to consider providing sex education to young women before they marry. More broadly, interventions designed to increase womens agency need to be tailored to the type of agency being examined.

TWO SONS AND A DAUGHTER: SEX COMPOSITION AND WOMEN'S REPRODUCTIVE BEHAVIOUR IN MADHYA PRADESH, INDIA

This article examines how the sex composition of womens current children at the start of a pregnancy interval influences both fertility desires and the full range of reproductive actions women may take to realize them, including temporary contraception, abortion and sterilization, in Madhya Pradesh, India, where popular notions of ideal family size and sex composition are dominated by son preference. The analysis is conducted using a dataset of 9127 individual pregnancy intervals from a 2002 statewide representative survey of 2444 women aged 15-39 with at least one child. The results indicate that womens preferences go beyond a singular preference for male children, with the preferred composition of children being two boys and one girl. Women with this composition are 90% less likely to report having wanted another pregnancy (OR 0.097, p < 0.01) relative to those with two girls. These preferences have significant implications for reproductive actions. While sex composition has no statistically significant effect on the use of temporary contraception, those with the preferred sex composition are twice as likely to attempt abortion (OR 2.436, p < 0.01) and twelve times more likely to be sterilized (OR 12.297, p < 0.01) relative to those with two girls only.

Changing what it means to 'become a man': participants' reflections on a school-based programme to redefine masculinity in the Balkans.

Calls to engage men and boys in efforts to promote health, prevent violence and advance gender equality have grown in recent years. However, there remains little evidence or reflection on how most effectively to change harmful norms related to masculinity. The study addresses this gap by exploring the perspectives of participants in the Young Men Initiative (YMI), an innovative programme that aimed to promote healthier masculinities among boys attending vocational high schools in several Balkan countries through educational workshops, residential retreats and a social marketing campaign. Qualitative data were collected through 37 in-depth interviews and 11 focus-group discussions with boys, youth facilitators and teachers. Findings from four schools (in Belgrade, Sarajevo, Prishtina and Zagreb) suggest that several elements of the programme resonated strongly with participants and supported their meaningful engagement in project activities. Five themes emerged as most salient in identifying how and why specific aspects of YMI positively influenced participants: personal reflection, experience-based learning, connections with youth facilitators, new peer groups and aspirational messaging. Building on these insights, the study highlights potentially useful strategies for other programmes seeking to reach boys and transform their understanding of masculinity.

Self-reported abortion-related morbidity: a comparison of measures in Madhya Pradesh, India.

CONTEXT Globally, abortion-related morbidity places a largely unmeasured physical, social and economic burden on women, yet little research has examined population-level morbidity, particularly in developing countries. METHODS Data were drawn from a representative 2002 survey in Madhya Pradesh, India, of married women aged 15-39 who had at least one child; the analysis examined 966 abortion attempts associated with 737 pregnancies. The prevalence and severity of self-reported morbidity were determined using a symptom-based measure and a bed rest-based measure. Comparative and concurrency analyses assessed how the measures captured and categorized morbidity, and how their results differed between rural and urban settings and by provider and method used. RESULTS Both measures found relatively high levels of abortion-related morbidity: The symptoms measure recorded morbidity in 58% and 46% of abortion attempts in rural and urban areas, respectively, and the bed-rest measure did so in 38% and 29% of attempts in these areas. With either measure, the proportion of attempts resulting in severe morbidity was higher for rural than for urban women. A substantial proportion of attempts were categorized as resulting in moderate or severe morbidity under the symptoms measure and in no morbidity under the bed-rest measure (16-20%), and a significant proportion were categorized as leading to severe morbidity under the first measure and to no or moderate morbidity under the second measure (6-17%). Differences also appeared in how the measures assessed morbidity according to the provider and method used. CONCLUSIONS Each measure captured a distinct dimension of abortion-related morbidity, which suggests that multiple measures should be used to more fully assess the burden of morbidity among women in developing countries.

Worth the effort? Combining sexual and reproductive health and economic empowerment programming for married adolescent girls in Amhara, Ethiopia

ABSTRACT Child marriage is an important driver of poor health outcomes at the global level, particularly for those related to sexual and reproductive health (SRH). Relatively few programs focus specifically on married adolescents, however, and most focus narrowly on SRH rather than broader well-being. Programming that combines SRH with economic empowerment (EE) may lead to greater well-being while enhancing the effectiveness of both programmatic components, but few evaluations have directly addressed this. This study explores the relative effectiveness of combined versus single-focus programming using data collected as a part of the evaluation of the Towards Economic and Sexual Reproductive Health Outcomes for Adolescent girls (TESFA) program in Amhara, Ethiopia. Between 2011 and 2013, linked baseline and endline data were collected from 2,272 ever-married adolescent girls aged 14–19 from three arms: the first including training on SRH only, the second integrating EE, and the third serving as a comparison group. The effect of participation in the different program arms is assessed against five SRH and three EE outcomes using difference-in-difference models. Participation in either intervention arm significantly improved four of the five SRH outcomes, with the largest gains in the single-focus arm. In contrast, those girls in the combined arm experienced improvements in two of the economic outcomes compared with one in the single-focus arm. These results provide strong support for broad program impact, but little evidence of a synergistic and mutually reinforcing relationship between the two program elements. Overall, the findings suggest that programmers may face a choice between a program model that delivers somewhat greater impact in terms of SRH outcomes and one that delivers somewhat smaller effects across a broader range of outcomes.

Reproductive Coercion and Contraceptive Use in Ethiopia

Context: While intimate partner violence (IPV) is recognized as a major contributor to poor reproductive health outcomes, the relationship between IPV and contraceptive use is unclear. Reproductive coercion (RC), a mechanism by which power is maintained over a partner through enforced reproductive behaviours, could be the missing link in understanding this relationship. However, there is limited understanding of RC and contraceptive use in sub-Saharan Africa. Data Source and Methods: We use large-scale population based survey data from Ethiopia and examine the relationship between reproductive coercion and contraceptive use and estimate the predictors of reproductive coercion using multivariate logistic regression models. Findings: Our findings suggest a strong negative association between RC and contraceptive use after adjusting for IPV and other factors, while emotional IPV was strongly predictive of RC. Conclusion: RC can be critical for understanding how controlling behaviours and violence manifest in the reproductive arena and impact family planning decision-making.